Steroid-induced ocular hypertensive response in pediatric patients with acute lymphoblastic leukemia.

PURPOSE: To report the characteristics of the steroid-induced ocular hypertensive response in pediatric patients with acute lymphoblastic leukemia (ALL) treated with prednisolone (PSL) during induction therapy and with dexamethasone (DEX) during reinduction therapy. STUDY DESIGN: Retrospective. PATIENTS AND METHODS: This study included pediatric patients diagnosed with B-cell precursor ALL and treated with systemic corticosteroids sometime during the period from 2016 to 2018 at Shizuoka Children's Hospital. Data were extracted from the hematology/oncology records related to the type, dose, and duration of systemic corticosteroids as well as to the ophthalmologic examination findings, intraocular pressure (IOP) data, symptoms of high IOP, and antiglaucoma medications obtained during corticosteroid administration. The maximal IOPs of the PSL and DEX groups were compared. RESULTS: Twenty-eight patients (18 boys and 10 girls; mean age 5.5 years) were treated with systemic corticosteroids. Twelve of the 22 courses of PSL and 33 of the 44 courses of DEX were found to be associated with high IOP. The maximal IOP was higher with the use of DEX than with the use of PSL, including in those who received prophylactic therapy (PSL 25.2 mmHg, DEX 33.6 mmHg; P = 0.02). Antiglaucoma medication was given to 21 patients; 6 patients had symptoms of ocular hypertension. The maximal IOPs were 52.8 mmHg and 70.8 mmHg in the PSL and DEX groups, respectively. Both groups of patients reported severe headache. CONCLUSION: Increased IOP was frequently observed during systemic corticosteroid therapy in pediatric patients with ALL. Although most patients were asymptomatic, they occasionally presented with severe systemic symptoms. Regular ophthalmologic examinations should be included in the treatment guidelines for ALL.

Usefulness of handheld electroretinogram system for diagnosing blue-cone monochromatism in children.

PURPOSE: To report the diagnosis of three childhood patients with blue-cone monochromatism (BCM) using S-cone electroretinograms (ERG) recorded with RETeval® Complete. STUDY DESIGN: Prospective clinical study. METHODS: We examined three boys initially suspected of having rod monochromatism. S-cone ERG was performed with red background and blue flashed light stimulation using two different intensities: 0.25 cd × s/m2 and 1 cd × s/m2. RESULTS: Case 1 was a 12-year-old boy with a visual acuity of 0.1 OU. Case 2 was an 8-year-old boy with a visual acuity of 0.3 OD and 0.2 OS. Both cases showed a myopic fundus and nystagmus without any other ocular abnormalities. Case 3 was a 6-year-old boy with a visual acuity of 0.3 OD and 0.4 OS. He also showed myopic fundus changes, but nystagmus was not observed. Rod and maximal responses recorded with RETeval® were likely to be within normal range; however, cone responses were absent in all cases. S-cone ERGs showed positive responses at 40 ms with 0.25 cd × s/m2 intensity in Case 2, and at approximately 30-40 ms with 1.0 cd × s/m2 intensity in all three cases. These ERG findings led to a diagnosis of BCM. CONCLUSIONS: S-cone ERG of RETeval® was helpful in diagnosing with minimal invasion BCM in childhood patients.

A case of retinal injury by a violet light-emitting diode.

PURPOSE: To describe the first case of retinal injury by a misuse of a toy using light-emitting diode. METHODS: A 15-year-old male Japanese student received irradiation on his right eye by a 5 mW light-emitting diode of 410 nm wavelength for 20 seconds in 2 days. He noticed decreased vision and central scotoma approximately 2 weeks later from these events. The mechanism of injury was evaluated from the estimated irradiance on the retina by comparison with experimental threshold data published. RESULTS: Chorioretinal atrophy with visual loss and central scotoma has remained on the fovea. The patient received an estimated dose of 1.58 J/cm 2 times, which was close to the experimentally determined radiant exposure for photochemical injury of rat retina. CONCLUSION: The violet light from light-emitting diodes is a potential hazard for the retina, and thus, direct viewing into the beam should be avoided. Children, especially, should not be allowed to play with such toys without being carefully instructed about their proper use and fully supervised.

[Morphological changes in exudative age-related macular degeneration after photodynamic therapy].

PURPOSE: Exudative age-related macular degeneration was classified into two types. Type 1 had choroidal neovascularization (CNV) below the retinal pigment epithelium (RPE) and type 1+2 had CNV extended into subretinal space. The morphological changes following photodynamic therapy were investigated for the two types. PATIENTS AND METHODS: One hundred and five eyes of 104 patients(mean age; 70.2 +/- 8.5 (SD) years-old) were classified by clinical findings with stereoscopic fundus observation, fluorescein angiography, and optical coherent tomography. The eyes with no exudative changes after successful treatment were divided into two types: sub-pigment epithelial dry type and sub-sensory retinal dry type. In the former, the lesions remained below the RPE and in the latter, fibrous scars persisted in the subretinal space. RESULTS: Exudation resolved in 73% of type 1 and in 67% of type 1+2 at 6 months after the initial treatment. Among eyes followed for more than one year, in 77% of type 1 and in 89% of type 1+2 the lesions became dry in a mean follow-up time of 23.9 -/+ 8.4 months with mean treatment times of 2.0 and 2.2, respectively. Type 1 improved to sub-pigment epithelial dry type, and type 1+2 to sub-sensory retinal dry type (p = 1.06 x 10(-10), chi-square test). Visual acuity of the former was better than the latter. CONCLUSIONS: We considered that exudation was resolved with CNV remaining beneath the RPE in type 1, and fibrous scar tissue was favorably formed in type 1+2.